MEDICARE: MR. LARRY H. CLONINGER L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	000027	MO

General Provider Information

NPI Number	:	1326158874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY H. CLONINGER L.P.C.

Provider Business Mailing Address
First Line	:	14312 DILLON OUTER RD
Second Line	:
City	:	SAINT JAMES
State	:	MO
Zip	:	65559-8790
Country	:	US
Telephone Number	:	573-578-0198
Fax Number	:	573-265-0371

Provider Business Practice Location Address
First Line	:	14312 DILLON OUTER RD
Second Line	:
City	:	SAINT JAMES
State	:	MO
Zip	:	65559-8790
Country	:	US
Telephone Number	:	573-578-0198
Fax Number	:	573-265-0371

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/09/2007

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